Background:Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland.Methods:We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause.Results:The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44–4.88]), consultation with a cardiologist (7.32 [6.83–7.84]), implantable cardioverter-defibrillator (1.40 [1.22–1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22–2.03]) but lower odds of emergency (0.88 [0.79–0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83–0.93]) and coronary artery bypass grafting (0.82 [0.71–0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% (P<0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% (P<0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures.Conclusions:Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.

中文翻译：

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创新的管理式护理可能与改善急性心肌梗死幸存者的预后有关

背景：心肌梗死幸存者出院后的死亡率仍然很高。因此，我们比较了参与和未参与针对波兰心肌梗死幸存者的新型全国管理式护理计划的心肌梗死幸存者的结局。方法：我们使用了公共数据库。我们纳入了 2017 年 10 月 1 日至 2018 年 12 月 31 日期间在波兰因急性心肌梗死住院的所有患者。我们从分析中排除了所有 <18 岁的患者以及住院期间或出院后 10 天内死亡的患者. 所有患者均接受前瞻性随访。主要终点定义为全因死亡。结果：平均随访时间为 324.8±140.5 天（78 034.1 患者年；观察期间未死亡的患者为 340.0±131.7 天）。参与管理式医疗计划与参与心脏康复 (4.67 [95% CI, 4.44–4.88])、心脏病专家会诊 (7.32 [6.83–7.84])、植入式心脏复律除颤器 (1.40 [ 1.22–1.61]) 和心脏再同步治疗与心律转复除颤器植入 (1.57 [1.22–2.03]) 但紧急情况 (0.88 [0.79–0.98]) 和非紧急经皮冠状动脉介入治疗 (0.88 [0.83–0.93]) 和较低的几率随访期间冠状动脉旁路移植术 (0.82 [0.71–0.94])。计划参与者的一年全因死亡率为 4.4%，匹配的非参与者为 6.0%。由全因死亡、心肌梗塞或中风组成的终点分别发生在 10.6% 和 12.0%（植入式心律转复除颤器 (1.40 [1.22–1.61]) 和心脏再同步治疗与心律转复除颤器植入 (1.57 [1.22–2.03]) 但发生紧急情况的几率较低 (0.88 [0.79–0.98]) 和非紧急经皮冠状动脉介入治疗 (1.57 [1.22–2.03]) [0.83-0.93]) 和冠状动脉旁路移植术 (0.82 [0.71-0.94]) 在随访期间。计划参与者的一年全因死亡率为 4.4%，匹配的非参与者为 6.0%。由全因死亡、心肌梗塞或中风组成的终点分别发生在 10.6% 和 12.0%（植入式心律转复除颤器 (1.40 [1.22–1.61]) 和心脏再同步治疗与心律转复除颤器植入 (1.57 [1.22–2.03]) 但发生紧急情况的几率较低 (0.88 [0.79–0.98]) 和非紧急经皮冠状动脉介入治疗 (1.57 [1.22–2.03]) [0.83–0.93]) 和冠状动脉旁路移植术 (0.82 [0.71–0.94]) 在随访期间。计划参与者的一年全因死亡率为 4.4%，匹配的非参与者为 6.0%。由全因死亡、心肌梗塞或中风组成的终点分别发生在 10.6% 和 12.0%（93]) 和冠状动脉旁路移植术 (0.82 [0.71-0.94]) 在随访期间。计划参与者的一年全因死亡率为 4.4%，匹配的非参与者为 6.0%。由全因死亡、心肌梗塞或中风组成的终点分别发生在 10.6% 和 12.0%（93]) 和冠状动脉旁路移植术 (0.82 [0.71-0.94]) 在随访期间。计划参与者的一年全因死亡率为 4.4%，匹配的非参与者为 6.0%。由全因死亡、心肌梗塞或中风组成的终点分别发生在 10.6% 和 12.0%（参与者和非参与者的P <0.01)，而参与者和非参与者的全因死亡或因心血管原因住院的比例分别为 42.2% 和 47.9% ( P <0.001)。参与和不参与管理式护理计划的患者之间的结果差异可以通过改善获得心脏康复、心脏护理和心脏手术的机会来解释。结论：心肌梗塞后管理式护理可能与改善预后有关，因为它可能有助于获得心脏康复，并可能提供更高标准的门诊心脏护理。